Which individual would a recommendation for an augmentative and alternative communication (AAC) intervention be least appropriate?

• A. A preschool child with a language-learning disorder and highly unintelligible speech
• B. A teenager with a repaired cleft palate who continues to experience hypernasality
• C. A young adult with severe cerebral palsy precluding functional oral communication
• D. A 55-year-old man who has had a laryngectomy

Answer: (B)

AAC is most appropriate when a person cannot meet daily communication needs through natural speech. A preschool child with a language-learning disorder who is highly unintelligible benefits from AAC because it provides a reliable way to express needs and participate in learning while speech develops. The teenager with repaired cleft palate who still experiences hypernasality presents a resonance issue that may be addressed with continued therapy or surgical/prosthetic options, so while AAC can be used as a supplement, it would not be the primary intervention to address the underlying problem; there is potential to improve natural speech here, making AAC less appropriate as the first choice. A young adult with severe cerebral palsy who cannot produce functional oral communication clearly needs AAC to communicate. A 55-year-old man after a laryngectomy relies on alternative means of communication, so AAC is essential.